Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study
Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study
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DOI：
10.1186/s13075-019-1997-5
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发表时间：
2019-10-12
影响因子：
4.9
通讯作者：
Lin, Chun-Yu
中科院分区：
文献类型：
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作者：
Hsu, Chung-Yuan;Ko, Chi-Hua;Lin, Chun-Yu
目的评估和比较各种系统性风湿病患者现实生活中机会性感染和带状疱疹的负担。方法采用13年的队列研究，比较5种风湿病患者中9种机会性感染的发病率。根据随访时间采用泊松回归进行分层分析，并采用Cox模型比较首次机会性感染的风险。结果2000-2013年，我们共发现76966例患者患有多发性肌炎/皮肌炎（PM/DM， 2270例）、系统性红斑狼疮（SLE， 15961例）、系统性硬化症（SSc， 2071例）、类风湿关节炎（RA， 38355例）或原发性干燥综合征（pSS， 18309例）。机会性感染的IR在PM/DM病例中最高（61.3/1000人-年，95%可信区间[CI] 56.6-66.2），其次是SLE病例（41.3 /1000人-年，95% CI 41.7-44.5）、SSc病例（31.6/1000人-年，95% CI 28.3-35.1）、RA病例（25.0/1000人-年，95% CI 24.4-25.7）和pSS病例（24.1/1000人-年，95% CI 23.1-25.2）。多变量Cox分析显示，相对于SLE， PM/DM与机会性感染的风险显著升高相关（风险比1.18,95% CI 1.08-1.29）。在确诊所有五种风湿病后的第一年，机会性感染的风险最高。结论PM/DM的机会性感染风险最高，其次是SLE、SSc、RA和pSS。对于选择的PM/DM患者，特别是在诊断后的第一年，可能需要仔细观察和预防性治疗机会性感染。
Objective To estimate and compare the burdens of opportunistic infections and herpes zoster in real-world practice among patients with various systemic rheumatic diseases. Methods This 13-year cohort study used national health insurance data to compare the incidence rates (IRs) of nine opportunistic infections among patients with five rheumatic diseases. The analyses were stratified according to follow-up duration using Poisson regression, and Cox models were used to compare the risk of first opportunistic infection. Results During 2000-2013, we identified 76,966 patients who had polymyositis/dermatomyositis (PM/DM, 2270 cases), systemic lupus erythematosus (SLE, 15,961 cases), systemic sclerosis (SSc, 2071 cases), rheumatoid arthritis (RA, 38,355 cases), or primary Sjogren's syndrome (pSS, 18,309 cases). The IR of opportunistic infections was highest for PM/DM cases (61.3/1000 person-years, 95% confidence interval [CI] 56.6-66.2), followed by SLE cases (43.1/1000 person-years, 95% CI 41.7-44.5), SSc cases (31.6/1000 person-years, 95% CI 28.3-35.1), RA cases (25.0/1000 person-years, 95% CI 24.4-25.7), and pSS cases (24.1/1000 person-years, 95% CI 23.1-25.2). Multivariable Cox analysis revealed that, relative to SLE, PM/DM was associated with a significantly higher risk of opportunistic infections (hazard ratio 1.18, 95% CI 1.08-1.29). The risk of opportunistic infections was highest during the first year after the diagnosis of all five rheumatic diseases. Conclusions The risk of opportunistic infection was highest for PM/DM, followed by SLE, SSc, RA, and pSS. Careful observation and preventive therapy for opportunistic infections may be warranted in selected PM/DM patients, especially during the first year after the diagnosis.